What issues might cause inability to properly flange upper lip? Tight frenulum? *pics added*

[smeep]

DD is just over 4 weeks old and we're still having nursing issues. It's not as bad (no wincing in pain for the most part) but it still hurts. I'm starting to wonder if her upper frenulum might be tight but wanted to know what other issues might be related and cause shallow latch. Here are the issues:

- She has what I like to call the "door knocker" upper lip (see: The Labyrinth ). It's not flanged at all and stays curved in. I pull it out and it just goes back in within a few seconds.

- She doesn't open wide enough 99% of the time. Rarely will she open wide enough and I can tell the difference immediately.

- She sometimes makes clicky noises (but not all the time). Sometimes they don't start until partway through the feed (sometimes at letdown), sometimes they're during the whole thing. Taking her off and putting her back on does not always fix it. 

- Sometimes I see milk seeping out. This further makes me question her suction.

- The last week-ish she has started the brand new thing of latching weird and basically pushing my breast in and out until it's totally out (like, out a bunch, in a little, out a bunch, in a little, then totally out). Or she won't push it completely out but I can easily pull it out without breaking the suction because by that time she's just on my nipple without any suction. But sometimes when she does this if I slowly pull the breast back a bit when I first notice it, she'll get what seems to be a good tight latch in about the right spot. So I don't know if she's latching on too far back and is pushing with her tongue or what. It's extremely confusing.

I'm going to see the IBCLC tomorrow (the same one who evaluated her at 2 weeks and just gave me some suggestions on getting her to open wider). She generally sucks the breast in far enough (from what I can tell) but it's the whole sucking it into place that is causing the pain, at least I assume so since the rare occasion that she latches great I have almost no pain.

So, sorry that's so long, but I appreciate the help!!!

ETA: Are there any comparison pictures anywhere of a tight upper frenulum vs. a normal one? It looks like that might be her deal but I can't tell because it's so hard to find pictures of each. :( And the same for tongue tie and different kinds of tongue tie, I'm wondering if possibly she has a really small one but I can't tell at all.

Here are pictures. Pretty sure she doesn't have a tongue tie but I included pictures anyway. Also included pictures of her upper frenulum.

Edited by smeep - 3/13/11 at 4:54pm

[homemademom]

That sounds exactly like my ds. He had both a tight, thick lip tie (the frenulum at the upper lip) and a posterior tongue tie (often a reason for clicking and pushing your nipple out). We had both clipped (well, with laser surgery) and now he can flange out his lip and stick out his tongue.  

Here are some links about tongue tie that I found especially helpful: http://www.cwgenna.com/quickhelp.html and http://www.lunalactation.com/KnoxTT.pdf

Also: http://www.lowmilksupply.org/tonguetie.shtml and http://www.llli.org/llleaderweb/lv/lvaprmay02p27.html